Tinnitus is the perception of sound when no external sound is present, often described as ringing, buzzing, hissing, or clicking. Many people experience tinnitus, often finding it worsens or becomes more noticeable at night. This increased prominence can be particularly disruptive.
The Amplification Effect of Silence
The absence of ambient noise at night makes tinnitus more prominent. During the day, everyday sounds provide a “masking” effect, helping to mask the internal sound of tinnitus. The brain processes external auditory information, reducing its focus on tinnitus.
As the environment becomes quiet at night, this masking effect is reduced or removed. With fewer external sounds to compete for attention, the internal sounds of tinnitus become more noticeable. Tinnitus does not become physiologically louder, but is perceived as louder due to the lack of competing sounds. This heightened perception can make an already bothersome condition feel more intense in the stillness of the night.
Physiological and Psychological Contributors
Several bodily and mental factors can make tinnitus seem worse at night. Changes in blood flow or body position when lying down might affect the perception of tinnitus. For example, pulsatile tinnitus, often described as a rhythmic whooshing or throbbing, can become more apparent with specific head positions or blood flow changes when lying down.
Underlying causes of tinnitus, such as noise exposure, earwax blockage, certain medications, Meniere’s disease, or temporomandibular joint (TMJ) disorders, can make tinnitus more noticeable at night. With fewer external stimuli, the brain may direct more attention to the internal sound, intensifying its perception.
Stress, anxiety, and rumination about sleep can heighten tinnitus perception. Without daily distractions, the brain may become more attuned to internal sensations. This awareness can create a cycle where sleep anxiety exacerbates tinnitus, making sleep more difficult.
The Link to Sleep Disturbances
The heightened perception of tinnitus at night can hinder sleep. The constant sound prevents the brain from relaxing and transitioning into sleep. This disruption leads to sleep deprivation, intensifying tinnitus perception.
Poor sleep can exacerbate stress and anxiety, creating a cycle where tinnitus causes sleep problems, which amplify tinnitus perception. Common sleep disorders, such as insomnia or sleep apnea, can worsen tinnitus. Addressing these sleep issues can improve tinnitus management.
Managing Tinnitus at Night
Strategies can help mitigate tinnitus perception and its impact on sleep. Sound therapy uses low-level background noise for a non-disruptive masking effect. White noise machines, fans, nature sounds, or soft music can obscure tinnitus, making it less noticeable. The goal is to blend ambient sound with tinnitus, not to drown it out.
Relaxation techniques can reduce stress and anxiety before bedtime. Mindfulness, meditation, deep breathing exercises, or progressive muscle relaxation can calm the nervous system, aiding in ignoring tinnitus and preparing for sleep. These practices shift focus from the internal sound and promote restfulness.
Practicing good sleep hygiene is beneficial. This includes a consistent sleep schedule, a comfortable sleep environment, and avoiding stimulants like caffeine or nicotine before bed. Creating a dark, quiet, and cool bedroom supports restful sleep.
Consult an audiologist or doctor if tinnitus significantly impacts daily life, is new, or is accompanied by hearing loss or dizziness. Professional guidance can lead to medical interventions or therapies, such as Tinnitus Retraining Therapy (TRT) or Cognitive Behavioral Therapy (CBT), to help manage tinnitus perception and improve quality of life.
References
Tinnitus: Ringing in the ears and what to do about it. Harvard Health. [Online]. Available: https://www.health.harvard.edu/diseases-and-conditions/tinnitus-ringing-in-the-ears-and-what-to-do-about-it. [Accessed 2024-08-05].
Tinnitus – Diagnosis and treatment – Mayo Clinic. [Online]. Available: https://www.mayoclinic.org/diseases-conditions/tinnitus/diagnosis-treatment/drc-20350162. [Accessed 2024-08-05].